A change of heart

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Speakers t the SMMGP 2020 Conference
Read the full article in DDN magazine

When a ‘general in the war of drugs’ calls the campaign a complete failure, it’s time to listen. DDN reports from the GPs’ conference.

‘For the last 40 years we have been fighting a war on drugs. I’ve been a general. We sought to deal with it through the hammer blow of the criminal justice system and I am sorry for having supported this war. It has been an utter failure.’

Lord Charles Falconer was addressing an audience of GPs at the recent RCGP/SMMGP conference on managing drug and alcohol problems in primary care. The former minister under Tony Blair’s government, whose roles had included justice secretary, said: ‘It’s time for us to acknowledge our failure and examine the evidence-based alternatives.’

‘Addiction knows no class barriers – everybody knows somebody who is affected,’ he said. Post- EU (and the conference was held on Britain’s withdrawal day), ‘the connection between those who know what they’re talking about and politicians has to be restored.’

One of the most obvious ways of ‘protecting the public from the cruel consequences of an obviously wrong policy’ would be to legalise and regulate drugs, taking them out of the hands of criminals. He referred to the 1961 Single Convention on Narcotic Drugs, ‘whose base was xenophobia’, and the 1971 Misuse of Drugs Act, a ‘pernicious policy’ which the UK has continued to support ‘even though it has brought death to thousands’.

‘You only need to look at overdose deaths compared to those countries who have moved away from punishment, such as Portugal, to see this approach is catastrophic,’ he said. Politicians were terrified of moving away from this approach because they were ‘worried about being characterised as flip-flop wearing liberals’.

‘We have produced some terrible soundbites – tough on crime, tough on the causes of crime’, he said, and the reliance on prohibition as the main tool had ‘gifted profit to criminals’. The main casualties had been the poorest, with not enough treatment and ‘terrifying numbers’ dying – most of these deaths preventable. Furthermore, we were trapped in a drug policy war: ‘Every pound we spend on prohibition, the more we spend on clearing it up.’

So what could be the way forward? There was a clear need for evidence-based policy, he said, and we had to take a harm reduction approach that was ‘holistic and non-judgemental’, giving access to services.

‘The government has to direct significant investment in drug services as a matter of urgency,’ he said, with funding made available to ensure heroin-assisted treatment, needle exchanges, naloxone, and consumption rooms (on a pilot basis, with evaluation), as well as testing at festivals.

‘The first priority must be to strengthen drug treatment services and develop harm reduction,’ he said, ‘and also improve the life chances of people who are recovering’. At the same time, we should review commissioning of services and look at improvements to the local model. He suggested setting up a central body for drug policy, reinstating a drug czar and considering a national agency to overview commissioning. The other vital call to action was to address the ‘crisis in the drug treatment workforce’, which included the drastic reduction in psychiatrist numbers.

‘People are no longer interested in high blown rhetoric, they want solutions,’ he said. ‘If people don’t like the way drugs affect their families and community, change will come.’

Ten year rollercoaster

National recovery champion, Dr Ed Day
National recovery champion, Dr Ed Day

Six months into his role as national recovery champion, Dr Ed Day reflected on the run-up to his appointment and the progress he had been able to make so far.

He was realistic about the capacity of his part-time unpaid role (alongside his other jobs), but also optimistic that his experience as a consultant addiction psychiatrist and knowledge of the sector contributed to evidence-based practice.

He talked of the ‘rollercoaster’ of the last ten years – first, the halcyon years of the Tony Blair decade, when there was a massive expansion of services around criminal justice and the advent of the NTA, ‘which drove a real interest in the evidence base’. GPs were able to drive up the quality of prescribing.

Then came the ‘crash’ of 2008, followed by the sweeping movement of recovery. ‘The positives that came out of that included peer support – but somehow it was couched as against what we did before,’ he said. ‘We need to combine harm reduction and recovery.’

‘We also need to try to change the system to a chronic care model,’ he said, citing Maslow – ‘you don’t reach actualisation unless you have something stable underneath’ – which could begin with needing methadone, for example.

The current threats loomed large – the reduction in budgets and turbulence in the commissioning system, combined with workforce issues that saw an exodus of skills and opportunities.

But ‘in the rush to manage risk and KPIs we forget how to relate to people,’ he said, with harm reduction and recovery both vital parts of the equation.

‘The development of peer-led recovery communities has stalled,’ he said, neglecting an opportunity for engagement and strategy. ‘We need to find a way to kickstart self-sustaining systems.’

Peer-led initiatives could help to tackle stigma head-on: ‘The real key is meeting someone who’s had the problem and recovered,’ he said. ‘It’s about giving people the key to change the situation themselves.’

Huge amount of instability

Dr Emily Finch
Dr Emily Finch

Speaking in the final session of the conference about the future of addictions treatment, Dr Emily Finch referred to the ‘huge amount of instability’.

‘All addictions treatment tends to be in a silo in local authorities,’ she said. ‘People don’t believe it when you say “we’re not running that service anymore”.’

There was also ‘a real loss of skills in the sector’. ‘When addiction psychiatrists retire, there will be no more in training,’ she said. Constant retendering had contributed to their reluctance to enter the workforce, and there were ‘almost no psychologists in addiction anymore’.

Survival functions

Dr Stephen Ryder, who gave a talk on liver disease, said that there was ‘a mismatch between what industry wants and what health and social care wants’. The fact that England was ‘still waiting for an alcohol strategy’ demonstrated this, and he encouraged GPs to keep working on survival functions.

‘The government won’t do anything, so we have to do something,’ he said. Despite high hospital admissions for alcohol-related diagnosis of liver disease, there were ‘significant deficiencies in action’ with essential early diagnosis not happening and more than half of people dying within two years of a late diagnosis.

In a conference called ‘Navigating the storm’ there was an atmosphere of battling through and looking for the patches of blue sky. But as seen in the conference message, the overwhelming response from GPs was – enough’s enough. Health and sensible policy must be first priority in this cash-starved sector to stop the scandal of drug and alcohol related deaths. DDN

Conference statement

We deplore that in 2020 drug-related deaths are the highest on record and now a public health crisis.

We call on the College to work with policy makers to not criminalise people who use drugs and implement all evidence-based harm reduction measures to reduce drug deaths including consumption rooms and heroin assisted treatment for those
who need it.

We call on the council to:

  • Recognise the devastating impact of lack of funding to drug and alcohol services since the 2012 Health and Social Care Act, with consequent destruction of shared care services and lack of workforce of those able to work effectively with people who use drugs.
  • Support minimum unit price for alcohol as the single most important harm reduction measure to reduce health inequalities and save lives for people who have alcohol problems.

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